Letter to Editor about Effect of Dried Ziziphus jujube Consumption on Plasma Insulin, Blood Pressure, Oxidative Stress, and Advanced Glycation End Products in Diabetic Patients with Excess Weight: A Randomized Controlled Trial

Dear Editor, We appreciate the recently published article “Effect of dried Ziziphus jujube Consumption on Plasma Insulin, Blood Pressure, Oxidative Stress, and Advanced Glycation End Products in Diabetic Patients with Excess Weight: A Randomized Controlled Trial” by Farhadnejad H et al.[1] This study provides promising insights, and the authors deserve commendation for their efforts, as it contributes to therapeutic benefits for diabetes mellitus type 2 (DM 2). After a thorough analysis of this study, we would like to respectfully highlight a few points that could potentially strengthen the research and provide a more refined understanding of the findings. First, the study included only 48 participants, among whom 8 participants discontinued, leaving behind a very small sample size, which raises concerns regarding statistical power. Furthermore, exclusive inclusion of only male participants would hinder its generalizability, as it overlooks sex-based differences in diabetes pathophysiology and oxidative stress responses.[2] Future studies should consider incorporating both genders to ensure relevance in the study. Secondly, the study evaluated a limited set of biomarkers, including insulin, blood pressure, total antioxidant capacity (TAC), malondialdehyde (MDA), and carboxymethyllysine (CML).[1] While these markers provide useful information, they do not completely assess the glycemic and oxidative stress status. Advanced oxidation protein products (AOPPs), fructosamine, and HbA1c were omitted from this study. Notably, HbA1c is the gold standard marker in the assessment of DM 2 and recent studies have also highlighted the diagnostic potential of fructosamine as integral indices.[3] Similarly, AOPPs are also reliable indicators to assess the oxidative stress in DM 2,[4] but in this study, these key biomarkers were not included. Last, one notable limitation of this trial was that it does not give a comprehensive understanding about Ziziphus jujube consumption on oxidative stress. The study only evaluates outcomes for the duration of 12 weeks, which may not be enough to apprehend the full effect of Ziziphus jujube on oxidative stress markers such as MDA, as they may require a longer timeframe to exhibit significant changes.[5] Therefore, it would be valuable for future studies to look into this aspect more thoroughly to understand the potential benefits of the Ziziphus jujube and its effects on oxidative stress in DM 2. Ethical approval No ethical approval was required as this letter to editor has no original data. Consent No patient consent was required as this letter to editor article does not include any patient data. Conflicts of interest The author declare no conflict of interest. Data availability statement No datasets were generated and analyzed during the current study. Funding No funding source was used. Author contributions Mubashira Noor: Contributed to writing and editing Aleeza Abid: Literature Review Mehlab Ansari: Conceptualization Saman Adnan Khan: Review And Editing